Provider Demographics
NPI:1326053968
Name:MEDWIZ SOLUTIONS LLC
Entity Type:Organization
Organization Name:MEDWIZ SOLUTIONS LLC
Other - Org Name:MEDWIZ SOLUTIONS LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:
Authorized Official - Last Name:NEWHOUSE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:845-624-8080
Mailing Address - Street 1:167 ROUTE 304 STE 101
Mailing Address - Street 2:SUITE 101
Mailing Address - City:BARDONIA
Mailing Address - State:NY
Mailing Address - Zip Code:10954-2050
Mailing Address - Country:US
Mailing Address - Phone:845-624-8080
Mailing Address - Fax:845-624-8055
Practice Address - Street 1:167 ROUTE 304 STE 101
Practice Address - Street 2:STE 101
Practice Address - City:BARDONIA
Practice Address - State:NY
Practice Address - Zip Code:10954-2050
Practice Address - Country:US
Practice Address - Phone:845-624-8080
Practice Address - Fax:845-624-8055
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-30
Last Update Date:2021-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 333600000X, 3336C0004X, 3336S0011X
NY0276983336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02740210Medicaid
2067658OtherPK
5619010001Medicare NSC